A Rare Case of Concurrent Typhlitis and Clostridioides difficile Colitis in an Acute Myeloid Leukemia (AML) Patient Undergoing Chemotherapy

Typhlitis (neutropenic enterocolitis) and Clostridioides difficile infection (CDI) are two separate medical conditions. Typhlitis is the inflammation of the cecum and usually occurs in neutropenic patients. CDI is a life-threatening disease of the digestive tract and affects immunocompromised patients. The challenge is when both conditions occur together, especially in patients with hematological malignancies and immune compromise post-chemotherapy. This report of a rare case aims to highlight the co-occurrence of typhlitis and CDI in a patient on chemotherapy after being diagnosed with acute myeloid leukemia (AML). The challenge addressed by this article is how to manage such complex cases in immunocompromised individuals. We report a case of a 41-year-old woman with a history of AML, who presented with fever, abdominal pain, and watery diarrhea after consolidation chemotherapy. Laboratory test results confirmed thrombocytopenia and severe neutropenia. Computed tomography confirmed typhlitis, while stool polymerase chain reaction was positive for toxigenic C. difficile. She was successfully treated with intravenous meropenem and metronidazole for typhlitis, alongside oral fidaxomicin for CDI, resulting in a significant improvement in the patient’s condition. This emphasizes the importance of diagnosing and creating a management plan that involves the careful selection of antibiotics that target both conditions without adverse interactions. In conclusion, this case adds to the limited literature on the co-occurrence of typhlitis and CDI, especially in patients with hematological malignancies after chemotherapy. It highlights the need for a high clinical suspicion and an individualized treatment plan for this dual pathology.